ATI RN
Client Safety Alternatives to Restraints Quizlet Questions
Question 1 of 9
A nurse has received change-of-shift report and is delegating tasks to the assistive personnel (AP). The nurse should tell the AP to complete which of the following tasks first?
Correct Answer: A
Rationale: The correct answer is A: Perform blood glucose monitoring of a client who has a prescription for short-acting insulin prior to breakfast. This task should be completed first because monitoring blood glucose levels is essential for clients with diabetes who are on short-acting insulin to prevent hypoglycemia. Timely monitoring allows the nurse to assess the client's current glucose level and adjust the insulin dose if needed before the client eats breakfast. Choice B is incorrect because applying a condom catheter to an incontinent client is important but not as time-sensitive as blood glucose monitoring for a client on short-acting insulin. Choice C is incorrect because while feeding a client with bilateral casts is important for nutrition and comfort, it is not as time-sensitive as monitoring blood glucose levels for a client on short-acting insulin. Choice D is incorrect because delivering a clean voided urine specimen to the laboratory is important for diagnostic purposes, but it is not as time-sensitive as monitoring blood glucose levels for a client on short-acting
Question 2 of 9
In a randomized controlled trial (RCT), participants are randomly assigned to either the experimental or the control group to:
Correct Answer: B
Rationale: The correct answer is B: Minimize selection bias. Random assignment in an RCT helps ensure that participants in the experimental and control groups are similar at baseline. This minimizes the risk of selection bias, where certain characteristics of participants influence study outcomes. Choice A is incorrect because the purpose of random assignment is not specifically to test treatment effectiveness but to minimize bias. Choice C is incorrect because random assignment does not directly increase sample size. Choice D is incorrect because providing a baseline measurement is not the primary purpose of random assignment in an RCT.
Question 3 of 9
Subnormal core body temperature
Correct Answer: B
Rationale: The correct answer is B: Hypothermia. Subnormal core body temperature indicates the body temperature is below normal range, which is characteristic of hypothermia. Hyperthermia refers to elevated body temperature, making choice A incorrect. Choices C and D are likely not provided as they do not directly relate to the concept of body temperature.
Question 4 of 9
The nurse is developing a plan of care for a client with disturbed body image. Which interventions would the nurse most likely include in the plan? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A (Establish rapport with the client) because building a trusting relationship is essential in addressing disturbed body image. By establishing rapport, the nurse can create a safe environment for the client to express their feelings and concerns. Choice B (Role model appropriate behavior) may not directly address the client's distorted body image issues and might not be as effective as building rapport. Choice C (Encourage client to make positive self-statements) may be helpful in boosting self-esteem, but it may not address the underlying causes of the disturbed body image. Choice D (Assist the client in accepting responsibility for own actions) is not directly related to addressing disturbed body image and may not be as effective as building rapport in this context.
Question 5 of 9
Nail cutting
Correct Answer: A
Rationale: The correct answer is A: Follow the curve. This is because nails naturally grow in a curved shape, so cutting them following the curve helps prevent ingrown nails and maintains the nail's natural shape. Cutting straight (option B) can increase the risk of ingrown nails and discomfort. Options C and D are incomplete, so they are incorrect choices. Following the curve when cutting nails is the most effective and safe approach for maintaining healthy nails.
Question 6 of 9
A patient with ARDS is being mechanically ventilated. The physician has ordered prone positioning. What is the primary reason for this intervention?
Correct Answer: D
Rationale: The correct answer is D. Prone positioning helps recruit collapsed alveoli by redistributing ventilation to dependent lung regions, improving oxygenation in ARDS. It enhances lung homogeneity and reduces stress on the dorsal lung regions. Choices A, B, and C are incorrect because prone positioning primarily aims to optimize oxygenation by improving lung ventilation and perfusion, rather than solely reducing diaphragm workload, enhancing perfusion to anterior lung segments, or mobilizing secretions.
Question 7 of 9
After prolonged cardiopulmonary bypass, a patient develops increasing shortness of breath and hypoxemia. To determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by left ventricular failure, the nurse will anticipate assisting with
Correct Answer: D
Rationale: The correct answer is D, inserting a pulmonary artery catheter. This is the most appropriate action to differentiate between ARDS and pulmonary edema caused by left ventricular failure. The pulmonary artery catheter can provide valuable information such as pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output. In ARDS, the pulmonary artery pressure and pulmonary capillary wedge pressure are typically low, whereas in pulmonary edema due to left ventricular failure, these pressures are elevated. Positioning the patient for a chest radiograph (A) would provide anatomical information but not differentiate between ARDS and pulmonary edema. Drawing blood for arterial blood gases (B) can provide information on oxygenation but may not be sufficient to differentiate between the two conditions. Obtaining a ventilation-perfusion scan (C) is not typically used to differentiate between ARDS and pulmonary edema.
Question 8 of 9
Oral temperature, best
Correct Answer: B
Rationale: The correct answer is B (Under tongue) for taking oral temperature. This method is widely used and recommended for its accuracy and convenience. Placing the thermometer under the tongue ensures direct contact with saliva, providing a more accurate reflection of core body temperature. Taking temperature in the gums (A) may not provide as reliable results due to variations in saliva production and positioning. No information is given for choices C and D.
Question 9 of 9
At the beginning of the shift, an RN is preparing assignments for a licensed practical nurse (LPN) and an assistive personnel (AP). Which of the following tasks should the nurse assign to the LPN?
Correct Answer: D
Rationale: The correct answer is D because inserting a nasogastric tube requires a higher level of skill and knowledge that an LPN possesses. LPNs are trained to perform more complex clinical tasks such as inserting nasogastric tubes. Postmortem care (A) is generally not within the scope of practice for LPNs. Measuring I&O (B) and obtaining weight (C) are tasks that can be safely delegated to assistive personnel as they are routine and do not require the clinical judgment and skill level of an LPN.